Back to One

It was a comment posted by "Cat, MD" on my prior post regarding my assessment of where the nation stood "week two" following the launch of the government's health insurance exchange website that caught my eye. To me, she(?) asked what might be the one of the more important questions posed on this blog that warrants consideration by every medical student and practicing doctor currently:

Dr. Wes,

You state that law and medicine do not mix, but it seems as if medical care will be driven by national politics for the indefinite future. The ACA and laws like it will directly affect how physicians can practice.

So what role should physicians try to play in this? The prospect of letting attorneys and accountants dictate medical practice unnerves me. But at the same time, few people go to medical school to become politicians. As a medical student, I feel that physicians need to be more involved in legislating, but how?

Perhaps this would be as good a time as any to step back and contemplate this incredibly challenging question. After all, more and more difficulties with our new law are appearing as its real nuts and bolts are revealed. Yet it is always easy to criticize the myriad of events that are unfolding: the botched Healthcare.gov website, the creation of new donut holes of health care coverage, or the real life problems with the restrictive health care system model we're creating. What can doctors possibly do to help resolve these challenges?

Like a difficult case that stumps the best of doctors, perhaps doctors should go back to one.

The idea is not mine but that of the late psychologist and disruptive thinker, Sheldon B. Kopp. When a doctor has a difficult case sitting before them and they have run out of ideas about how to help that patient, he recommends the doctor go back to one. What do you know how to do well? What can you contribute to this patient. What have you tried that did not work?

Back to one.

From Dr. Kopp's book, "If You Meet the Buddha on the Road, Kill Him: The Pilgrimage Of Psychotherapy Patients:"

“Crises marked by anxiety, doubt, and despair have always been those periods of personal unrest that occur at the times when a man is sufficiently unsettled to have an opportunity for personal growth. We must always see our own feelings of uneasiness as being our chance for "making the growth choice rather than the fear choice.”

We have tried Red and Blue solutions for health care reform and should be asking ourselves how they are working out. What has worked? What hasn't? What can each of us bring to the health care table? What needs to be done? Is a centralized control of health care our best solution, or might there be something else?

Of course, none of this is easy. It is not easy to take risks. It is not easy to think we might not just be able to sit back and ignore the difficulties that arise when biased third-parties control the show. But when we begin by going back to one, there is an opportunity for meaningful change that benefits doctors and patients alike.

For today's doctors, Dr. Kopp offers a useful visual:

“There is the image of the man who imagines himself to be a prisoner in a cell. He stands at one end of this small, dark, barren room, on his toes, with arms stretched upward, hands grasping for support onto a small, barred window, the room's only apparent source of light. If he holds on tight, straining toward the window, turning his head just so, he can see a bit of bright sunlight barely visible between the uppermost bars. This light is his only hope. He will not risk losing it. And so he continues to staring toward that bit of light, holding tightly to the bars. So committed is his effort not to lose sight of that glimmer of life-giving light, that it never occurs to him to let go and explore the darkness of the rest of the cell. So it is that he never discovers that the door at the other end of the cell is open, that he is free. He has always been free to walk out into the brightness of the day, if only he would let go. (192)”

If only we would let go.

To start, I believe there are a few prerequisites young and older doctors alike from either side of the political aisle should consider to help bring meaningful change to the health care reform discussion:

Be a Good Doctor: Nothing will improve your credibility as a spokesperson on behalf of your patients if you keep their interests first. This whole reform efforts is, after all, about them.

Get Involved: If you don't vote, you can't complain about who is elected. In the same way, if you don't get involved in voicing your concerns (and this is important) attempting to offer new, helpful solutions to problems faced by your patients, how will things ever improve for them?

Connect: None of us are politicians. None of us are lawyers (well, a few might hold dual degrees...). But doctors should be asking themselves, how have the politicians handled things to date? Maybe it's time to rethink our strategy for reform. Maybe Washington's solutions aren't our patient's best solutions. But is there a different way, an alternate strategy?

The vast majority of doctors are on the front line of caring for patients. Most are incredibly busy. And the majority are a devoted bunch with authority when it comes to patient care (believe it or not). We can offer solutions. Some are likely to fall on deaf ears, but some may not. But if we don't speak up and consistently advocate for our patients' medical needs over basic or mandated business concerns, our patients will suffer and we will be sidelined.

Some have suggested that social media might be a place where doctors' voices can be heard. Perhaps. But while doctors can voice our thoughts and ideas on social media, I am increasingly convinced that this is not where real change will occur. We need to bring our thoughts and ideas back home to our communities. Doctors need to take back medicine by going back to one and dig deep to offer small solutions one at a time locally, at home, not on some large bureaucratic national stage that is driven by special interests.

Cat, MD's question is the nugget: "... but how?" "Back to One" is just one idea. There are others. But maybe the best way to start changing health care for the better is to start asking the right questions and offering our own solutions for ourselves and our patients.

-Wes